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Erkrankungen der Adnexe in den Tropen: Amniontransplantation bei nichtinfektiösen Trachom-assoziierten Hornhautulzera

Diseases of the adnexa in the tropics: amnion membrane transplantation for noninfectious trachoma-associated corneal ulcers

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Zusammenfassung

Hintergrund

Hornhautulzera mit Fornixverkürzung in Spätstadien vernarbender Trachome stellen einen wesentlichen Anteil an Blindheit in vielen Entwicklungsländern dar. Wir haben die Möglichkeit einer Oberflächen- und Fornixrekonstruktion mit Amnionmembran untersucht.

Patienten und Methoden

Von 2001–2005 wurde bei 25 Augen von 17 Patienten mit trophischen Hornhautulzera und Symblephara (vernarbendes Trachom: 19 Augen von 14 Patienten, Stevens-Johnson-Syndrom: 4 Augen von 2 Patienten, Laugenverätzung: 2 Augen eines Patienten) kryokonservierte humane Amnionmembran in einer kontrollierten Kohortenstudie transplantiert. Nachuntersuchungen erfolgten bis zu 6 Monaten. Für die Statistik wurde Fischers exakter Test verwendet.

Ergebnisse

Von 25 Augen zeigten 9/19 mit Trachom, 3/4 mit Stevens-Johnson-Syndrom und 2/2 mit Laugenverätzungen nach 28–35 Tagen (Mittel 31±2,3 Tage) eine zunächst vollständige Reepithelialisierung. Die primäre Erfolgsrate bei Trachomaugen war nichtsignifikant unterschiedlich zu den anderen Indikationen (p=0,256). Sechs Monate postoperativ hatten 15/19 Trachomaugen (79%) verglichen mit 2/6 Nichttrachomaugen (33,3%) Symblephararezidive (p=0,0592) und 13/15 Trachomaugen (86,6%) wiesen eine erneute Hornhautvaskularisation (p=0,1752) auf. Eine persistierende Reepithelialisierung nach 6 Monaten konnte bei 1/19 Trachomaugen (5,3%) verglichen mit 4/6 Nichttrachomaugen (66,7%, p=0,005) festgestellt werden. Drei von 19 Trachomaugen mit Ulkusrezidiven waren nach 6 Monaten perforiert.

Schlussfolgerung

Humane Amnionmembran ohne die Verwendung von Mitomycin C kann zur Oberflächenrekonstruktion bei Patienten mit vernarbendem Trachom verwendet werden, allerdings sind die Langzeitergebnisse bei dieser Methode durch erneute Vernarbung limitiert.

Abstract

Background

Corneal ulcers with fornix shortening associated with late stages of cicatrizing trachoma contribute significantly to blindness in many developing countries. We report on the outcome of ocular surface and fornix reconstruction using amnion membrane transplantation.

Patients and methods

From 2001 to 2005, cryopreserved human amnion membrane without mitomycin C was grafted to 25 eyes of 17 patients with trophic corneal ulcers and symblepharon (cicatrizing trachoma: 19 eyes of 14 patients, Stevens-Johnson syndrome: 4 eyes of 2 patients, alkali burns: 2 eyes of 1 patient) in a controlled case series. Follow-up was done up to 6 months. Statistics: Fischer’s exact probability test.

Results

Of 25 eyes, 9 of 19 eyes with trachoma, 3 of 4 eyes with Stevens-Johnson syndrome, and 2 of 2 eyes with chemical burns showed complete reepithelialization and stromal recovery after 28–35 days (mean: 31±2.3 days). The primary success rate of trachoma eyes was not significantly different from the other indications (p=0.256). At 6 months post-op, 15 of 19 trachoma eyes (79%) compared to 2 of 6 non-trachoma eyes (33.3%) had developed a recurrence of symblephara (p=0.0592), and 13 of 15 eyes (86.6%) with a cicatricial trachoma compared to 1 of 6 with non-trachoma diagnosis experienced a recurrence of corneal vascularization (difference nonsignificant: p=0.1752). Persistent long-term reepithelialization was observed only in 1 of 19 trachoma eyes (5.3%) versus 4 of 6 non-trachoma eyes (66.7%, p=0.005); 3 of 19 trachoma eyes with a recurrence of ulcers had perforated after 6 months.

Conclusions

Human amnion membrane without mitomycin C can be used for ocular surface reconstruction in selected patients with cicatrizing trachoma. Its efficacy in the long-term rehabilitation of cicatrizing trachoma seems to be limited due to the progressive scarring.

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Literatur

  1. Adds PJ, Hunt CJ, Dart JK (2001) Amniotic membrane grafts, fresh or frozen? A clinical and in vitro comparison. Br J Ophthalmol 85(8): 905–907

    Article  PubMed  Google Scholar 

  2. Arora R, Mehta D, Jain V (2005) Amniotic membrane transplantation in acute chemical burns. Eye 19: 273–278

    Article  PubMed  Google Scholar 

  3. Beatty WL, Byrne GI, Morrison RP (1994) Repeated and persistent infection with chlamydia and the development of chronic inflammation and disease. Trends Microbiol 2: 94–98

    Article  PubMed  Google Scholar 

  4. Chen HJ, Pires RT, Tseng SC (2000) Amniotic membrane transplantation for severe neurotrophic corneal ulcers. Br J Ophthalmol 84(8): 826–833

    Article  PubMed  Google Scholar 

  5. Dean D, Powers VC (2001) Persistent chlamydia trachomatis infections resist apoptotic stimuli. Infect Immun 69: 2442–2447

    Article  PubMed  Google Scholar 

  6. Frick KD, Basillion EV, Hanson CL, Colchero MA (2003) Estimating the burden and economic impact of trachomatous visual loss. Ophthalmic Epidemiol 10(2): 121–129

    Article  PubMed  Google Scholar 

  7. Jain S, Rastogi A (2004) Evaluation of the outcome of amniotic membrane transplantation for ocular surface reconstruction in symblepharon. Eye 18: 1251–1257

    Article  PubMed  Google Scholar 

  8. Khandekar R, Mohammed RAJ, Negrel AD, Al-Riyami A (2002) The prevalence and causes of blindness in the Sultanate of Oman: the Oman Eye Study. Brit J Ophthalmol 86: 957–962

    Article  Google Scholar 

  9. Kim JC, Tseng SCG (1995) Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas. Cornea 14: 473–484

    PubMed  Google Scholar 

  10. Kozak I, Trbolova A, Sevcikova Z et al. (2002) Superficial keratectomy, limbal autotransplantation and amniotic membrane transplantation in the treatment of severe chemical burns of the eye. Act Vet BRNO 71: 85–91

    Google Scholar 

  11. Kruse FE, Rohrschneider K, Voelcker HE (1998) Transplantation of amniotic membrane for reconstruction of the eye surface. Ophthalmologe 95(2): 114–119

    Article  PubMed  Google Scholar 

  12. Kruse FE, Joussen AM, Rohrschneider K et al. (2000) Cryopreserved human amniotic membrane for ocular surface reconstruction. Graefes Arch Clin Exp Ophthalmol 238(1): 68–75

    Article  PubMed  Google Scholar 

  13. Kruse FE, Meller D (2001) Amniotic membrane transplantation for reconstruction of the ocular surface. Ophthalmologe 98(9): 801–810

    Article  PubMed  Google Scholar 

  14. Lee SH, Tseng SC (1997) Amniotic membrane transplantation for persistent epithelial defects with ulceration. Am J Ophthalmol 123: 303–312

    PubMed  Google Scholar 

  15. Nava-Castaneda A, Tovila-Canales JL, Monroy-Serrano MH et al. (2005) Comparative study of amniotic membrane transplantation, with and without sumultaneous application of mitomycin C in conjunctival fornix reconstruction. Arch Soc Esp Oftalmol 80(6): 345–352

    PubMed  Google Scholar 

  16. Polack S, Brooker S, Kuper H et al. (2005) Mapping the global distribution of trachoma. Bull WHO 83: 913–919

    PubMed  Google Scholar 

  17. Prabhasawat P, Barton K, Burkett G, Tseng SCG (1997) Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. Ophthalmology 104: 974–985

    PubMed  Google Scholar 

  18. Prabhasawat P, Tesavibul N (2001) Preserved amniotic membrane transplantation for conjunctival surface reconstruction. Cell Tissue Bank 2: 31–39

    Article  PubMed  Google Scholar 

  19. Prabhasawat P, Tesavibul L, Komolsuradej W (2001) Single and multilayer amniotic membrane transplantation for persistent corneal epithelial defect with and without stromal thinning and perforation. Br J Ophthalmol 85(12): 1400–1401

    Article  PubMed  Google Scholar 

  20. Solomon A, Meller D, Prabhasawat P et al. (2002) Amniotic membrane grafts for nontraumatic corneal perforations, descemetoceles, and deep ulcers. Ophthalmology 109(4): 694–703

    Article  PubMed  Google Scholar 

  21. Solomon A, Espana EM, Tseng SC (2003) Amniotic membrane transplantation for reconstruction of the conjunctival fornices. Ophthalmology 110: 93–100

    Article  PubMed  Google Scholar 

  22. Sridhar MS, Sagwan VS, Bansal AK, Rao GN (2001) Amniotic membrane transplantation in the management of shield ulcers of vernal keratoconjunctivitis. Ophthalmology 108: 1218–1222

    Article  PubMed  Google Scholar 

  23. Tseng SCG, Prabhasawat P, Lee SH (1997) Amniotic membrane transplantation for conjunctival surface reconstruction. Am J Ophthalmol 124: 765–774

    PubMed  Google Scholar 

  24. Tseng SC, Di Pascuale MA, Liu DT et al. (2005) Intraoperative mitomycin C and amniotic membrane transplantation for fornix reconstruction in severe cicatricial ocular surface diseases. Ophthalmology 112(5): 896–903

    Article  PubMed  Google Scholar 

  25. Ucakhan, Omur O, Gultekin K, Esin F (2002) Nonpreserved human amniotic membrane transplantation in acute and chronic chemical eye injuries. Cornea 21(2): 169–172

    Article  PubMed  Google Scholar 

  26. West SK (2004) Trachoma: a new assault on an ancient disease. Prog Retin Eye Res 23: 381–401

    Article  PubMed  Google Scholar 

  27. Whittum-Hudson JA, Taylor HR (1994) Immunology of trachoma. In: Bialasiewicz AA, Schaal KP (eds) Infectious diseases of the eye. Butterworth-Heinemann, Stoneham, Mass, pp 605–613

  28. Zhou SY, Chen JQ, Chen LS et al. (2004) Long-term results of amniotic membrane transplantation for conjunctival surface reconstruction. Zhonghua Yan Ke Za Zhi 40: 745–749

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology and School of Ophthalmic Technicians, College of Medicine and Health Sciences of the Sultan Qaboos University, 123 Al Khod, Muscat, Oman

    A. A. Bialasiewicz, R. Shenoy & A. Thakral

  2. Department of Epidemiology and Medical Statistics, College of Medicine and Health Sciences of the Sultan Qaboos University Muscat/Oman

    A. Al-Muniri

Authors
  1. A. A. Bialasiewicz
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  2. R. Shenoy
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  3. A. Al-Muniri
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  4. A. Thakral
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Correspondence to A. A. Bialasiewicz.

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Bialasiewicz, A.A., Shenoy, R., Al-Muniri, A. et al. Erkrankungen der Adnexe in den Tropen: Amniontransplantation bei nichtinfektiösen Trachom-assoziierten Hornhautulzera. Ophthalmologe 103, 940–944 (2006). https://doi.org/10.1007/s00347-006-1377-9

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  • DOI: https://doi.org/10.1007/s00347-006-1377-9

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